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Occupational Therapy and the Adopted Child. Megan Bresnahan , OTR/L University of Minnesota Amplatz Children’s Hospital. What is the International Adoption Clinic?. Pre-adoption review Post-adoption visit Ongoing support. Trends.

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Occupational therapy and the adopted child

Occupational Therapy and the Adopted Child

Megan Bresnahan, OTR/L

University of Minnesota Amplatz Children’s Hospital

What is the international adoption clinic
What is the International Adoption Clinic?

  • Pre-adoption review

  • Post-adoption visit

  • Ongoing support


  • Changes are seen in the countries that we see children from

  • More restrictions

  • Hague Adoption Convention


  • Support for institutions

  • Nutrition

  • Access to medical care

  • Substance use/abuse

  • Foster care vs institutional care

  • Foods

  • Promotion of adoptions within country


  • Mostly orphanage careand some models moving more to a foster care model

  • 2005: 7903

  • 2011: 2587


  • Orphanage Care

  • 2004: 5862

  • 2011: 962


  • Increased scrutiny

  • Orphanage care

  • 2004: 284

  • 2010: 2511

  • 2011: 1732


  • US is not currently processing adoptions from Guatemala

  • 2007: 4726


  • Orphanage care

  • 2004: 406

  • 2011: 226

South korea
South Korea

  • Foster Care

  • Some orphanage care for older children and children with special needs

  • 2004: 1713

  • 2011: 736


  • Typically orphanage care

  • 2006: 344

  • 2011: 216


  • Orphanage care

  • 2004: 355

  • 2009: 330

  • 2011: 33

Marshall islands
Marshall Islands

  • Relatively new

  • Child is typically with birth family until adoption

  • 2009: 22

  • 2010: 19

Factors affecting development
Factors Affecting Development

  • Genetic Background

  • Pre-natal care

  • Birth History

  • Age at time of Adoption

  • Country of origin

  • Cultural Issues

  • Living environment prior to adoption: foster home vs. institution including orphanage or hospital vs. time with birth family

  • Length of time in orphanage care and number of placements/transitions

Factors affecting development cont
Factors Affecting Development cont.

  • Quality of care in institution (caregiver to child ratio, etc.)

  • Malnutrition

  • Eating and Sleep Disturbances

  • Abuse (physical, sexual or emotional)

  • Trauma

  • Medical/health problems

  • Lack of developmental stimulation

  • Language delays

  • Sensory deprivation

  • Attachment disorders

  • Separation and loss issues

  • Substance Exposure

Startling numbers
Startling Numbers

  • A general guideline is that for each 3 months in an institution a child will lose approximately 1 month of development

Other factors to consider
Other factors to consider

  • Families adopting more than one child at a time

  • Parents with limited parenting experience

Speech and language considerations
Speech and Language Considerations

  • Model language; avoid correcting as it may inhibit the child from trying to speak

  • Avoid television

  • Many behaviors associated with attachment disorders and ADHD are also seen in children who are just learning English or who have speech and language delays

  • Children learn conversational English first, after several years language skills for academic learning

  • Encourage imaginary play

Cognitive and learning considerations
Cognitive and Learning Considerations

  • Lack of early stimulation may have long term effects on learning

  • Memory problems may be present

  • Initially, consider placing a child in developmentally appropriate setting rather than age appropriate

Social emotional and attachments disorder considerations
Social, Emotional and Attachments Disorder Considerations

  • Children need to adjust to their new family and all of the changes that they are experiencing

  • Initially, the primary caregivers should be the main people to provide for the child’s basic needs

  • Maximize the amount of time that the parents are with the child

  • Consistency and routines are helpful

  • Minimize the number of settings that the child is in

  • Children may functional at higher levels in other areas of development than in emotional development


  • School based therapy services

  • Medically based therapy services

  • Psychology

  • Neuropsych testing

  • Other specialists

  • When to start?

Attachment in ot
Attachment in OT

  • Utilize routine and structure in the session

  • Family Involvement

  • Parent permission

  • Indiscriminate friendliness

  • “High Fives”

Sensory processing concerns
Sensory Processing Concerns

  • Sensory deprivation, lack of sensory experiences may have effects on sensory system

  • This may cause the child to have a difficult time processing sensory input in a new environment

Sensory deprivation
Sensory Deprivation

  • If a child lived in an institution, she or he may have missed sensory experience

  • The child may not have been held, rocked, talked to or sung to

  • In a crowded orphanage, a small child might spend large portions of the day in a crib with little to do and not placed in a variety of positions

  • There may have been little chance to feel different textures, see different sights, hear different sounds or taste a variety of foods

Sensory deprivation1
Sensory Deprivation

  • A child may not have been played with or given the chance to run, jump, climb or play with toys

  • All of these activities provide sensory information to the brain, which interprets and organizes it

  • Without exposure to these activities, the brain does not learn how to appropriately use the information

  • Then when a child has new sensory experience, he or she may be over- or under-sensitive to the experience


  • Very individual for each child


  • 2005 study at the U of MN studied 222 kids from Eastern Europe; 12% with full or partial FASD

  • New FASD study

  • Growth Endocrine Study

  • Nutrition and International Adoption Study

Organizations working to improve orphan care
Organizations working to improve Orphan care

  • SPOON foundation (http://spoonfoundation.org)

  • Half The Sky (www.halfthesky.org)

  • Orphans at Play (www.OAP.com)

  • Mission to Promote Adoption in Korea (www.mpak.com)

  • The Red Thread Promise

  • Worldwide Orphans Foundation (www.wwo.org)